The silent killer we can't seem to live without

Peter Munro

TREVOR Beard was lean and fit, almost 60 but still cycling to work in winter. He ate plenty of fruit and vegetables, yet his blood pressure was tipping towards a dangerous level. Searching for a remedy in 1979, the general practitioner spied a medical journal editorial headed: ''Hypertension - salt poisoning?''

''I don't recommend old age if you can avoid it but I am doing all right at 90,'' he says from Hobart. The secret was stripping salt from his diet, replacing processed foods with a healthy spread of fresh fruit and vegetables and low-salt products.

Consumers may be tiring of health warnings about sugar, fats and alcohol. But there is one product health specialists say is a real, and silent, killer, which should be the focus of an urgent federal government public awareness campaign: salt.

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''It's like with alcoholics - everybody is in denial about salt, they don't want to know,'' Dr Beard says. ''But it's a health concern facing all Australians - they are all having far too much salt.''

Around the world, governments are beginning to prioritise salt ahead of the obesity epidemic in the hope of saving millions of lives lost to heart disease. But experts say Australia is way behind countries such as Britain, which introduced salt-reduction targets in 2005.

''In the 1980s we led the world in terms of research studies demonstrating the adverse effects of salt on blood pressure,'' says Caryl Nowson, professor of nutrition and ageing at Deakin University. ''Now we're probably about five years behind the UK. In the UK they had politicians publicly advocating to get salt out of the food supply but here it really doesn't have the support of government.''

Australians consume about nine grams of salt a day - more than double the official suggested dietary intake of four grams. The recommended daily maximum intake for adults is six grams, or 1½ teaspoons.

Heart disease is Australia's leading killer, accounting for more than a third of all deaths. But simply cutting salt intake by a third could save 35,000 lives a year, including a quarter of all stroke victims, says the Australian arm of the World Action on Salt and Health.

''Salt reduction is the single most cost-effective way of saving life,'' says co-ordinator Jacqui Webster. ''It is a no-brainer that governments should be implementing salt-reduction campaigns and the good news is they are starting to do so.''

Overseas, proposals to cull dangerous levels of the so-called ''white death'' include mandatory caps in food, bans on the use of salt in restaurants and a ''salt tax'' on unhealthy foods, none of which are being considered here.

''When I came to Australia in the 1980s there was a lot of talk about salt then, about keeping it down and healthy eating. But unfortunately you seem to have lost the plot and the food industry has taken over.

''Particularly now the rest of the world is doing it, why should Australia be so far behind - what the hell happened?''

Mounting evidence of salt's links to high blood pressure, or hypertension, and in turn cardiovascular disease, demands urgent action, says Dr Armstrong, an Australian health expert based in Geneva. ''High blood pressure is responsible for 13 per cent of all deaths, greater than tobacco, greater than any other risk factors … That in itself says it should be top of the list globally.''

Measures discussed at a WHO meeting of health experts this month, in London, included a tax on high-salt foods and regulations to cap so-called ''invisible'' salt levels in processed foods, such as bread and cereals.

There are signs Australia, too, is beginning to take salt seriously. The federal government has targeted salt, ahead of fats and sugars, in discussions with the food industry. In March, food manufacturers agreed to voluntary salt reduction targets for breads and breakfast cereals - which make up more than 40 per cent of Australians' salt intake. Targets for processed meats and simmer sauces are expected this year.

Government-backed salt reduction targets in Britain, first set in 2005 for more than 80 categories of food, have helped save 6000 lives a year. Salt intake has dropped from 9.5 to 8.6 grams a day. The strategy cost £15 million (A$26 million) but resulted in £1.5 billion in health savings, Professor MacGregor says.

About 75 per cent of Australians' daily salt intake comes from processed foods. A study in February showed more than 70 per cent of processed meats, cheeses and sauces contain unacceptably high levels of sodium, which in dietary terms is essentially sodium chloride, or salt. In April, a report commissioned by the US Congress found sodium levels have risen since the 1970s to unsafe levels, as people eat more processed and restaurant food. The Institute of Medicine report called for mandatory national targets to decrease maximum salt levels gradually, to ensure food remains appealing to consumers.

A campaign launched this year in New York seeks to curb salt in packaged and restaurant food by 25 per cent over the next five years. A member of the city's legislative assembly has separately introduced a bill to ban salt in restaurant kitchens.

Under Australia's new voluntary salt-reduction targets, leading manufacturers such as George Weston Foods and Goodman Fielder Baking have agreed to reduce sodium in bread to 400 milligrams per 100 grams by the end of 2013. Cereal producers such as Kellogg and Sanitarium agreed to reduce sodium content by 15 per cent for products that exceed 400 milligrams per 100 grams. The standard for low-salt products is considerably lower: 120 milligrams per 100 grams.

Melbourne nutrition expert Dr Russell Keast, co-author of The Salt Book, published in March, says mandatory caps on salt are essential to ensure a ''level-playing field'' for all food manufacturers. The main problem lies with ''invisible'' salt in major dietary sources, he says. ''Bread may contain 1.6 per cent sodium chloride yet not taste salty. You put this level of salt in water and it is undrinkable.''

People have an inbuilt preference for the taste of salty foods, which can be traced back to the emergence of species from the sea. ''Behaviour change is very difficult,'' he says. ''Some major food companies have done very good work at reducing levels of sodium in foods without advertising it is being done. They realise there are negative public perceptions of low-salt foods - they are generally viewed as tasteless.'' The Australian Food and Grocery Council argues the industry has been proactive without the threat of regulation. The industry body similarly rejects calls for ''traffic light'' food label warnings, currently being considered under a national labelling review. Salt is ''the next chapter in the story as to how the food industry responds to consumer health needs'', says deputy chief executive Dr Geoffrey Annison.

Low-salt products have not attracted the same zeal with consumers as low-sugar or reduced fat products. Kellogg has quietly reduced salt in Cornflakes and Rice Bubbles by a third since 1997. Both products remain high in salt, at about 680 milligrams per 100 grams. ''I don't think Australians are ready to embrace low-salt products yet,'' says communications manager Tina Wall. ''Until we get to a situation where consumers are actively seeking low-salt options then we will continue to do it with little fanfare.''

Professor Garry Jennings, director of the Baker Heart Research Institute, says salt is essential to normal bodily functions, such as maintaining the integrity of cells. But people need only one to two grams a day.

''There are communities around the world that have been studied that eat virtually no salt and what they don't have, which we do, is a rise in blood pressure when they get older.''

Patients find it relatively easy to reduce salt intake, he says. ''People miss the taste of salt, at least for a while. My view as a physician is it's one of the easy things to give up.

''Food tastes funny for a couple of weeks but with cigarettes and alcohol the urge continues almost indefinitely.''

Trevor Beard, who has led programs designed to help patients lower their salt intake, says going cold turkey was surprisingly easy. His daily intake has dropped to a subsistence level two grams and his blood pressure to 120/80 - remarkable for his age.